(1) "Nonhospital laboratory and radiology (x-ray) services" are professional and technical laboratory and radiology services which are ordered and provided by a physician, dentist, or other practitioner licensed within the scope of his practice as defined by state law.

(2) Nonhospital laboratory and radiology (x-ray) services may be provided in an office or similar facility other than a hospital outpatient department or clinic.

(3) Providers must meet the following requirements:

(a) Providers of laboratory services must be:

(i) Medicare certified; and

(ii) meet licensing requirements of the state in which they are located.

(b) Providers of radiology services must:

(i) be supervised by a physician who is licensed to practice medicine within the state in which the services are provided; and

(ii) meet state facility licensing requirements, if applicable.

(4) The definitions found in the introduction to Physicians Current Procedural Terminology, fourth edition (CPT4), published by the American Medical Association of Chicago, Illinois and adopted at ARM 37.86.101 defines the terms commonly used by the Montana Medicaid program in implementation of the program's nonhospital laboratory and radiology (x-ray) fee schedule.

(5) The "Physician-Related Services Manual" adopted at ARM 37.86.101 governs the administration of the Nonhospital Laboratory and Radiology (X-ray) program.


History: 53-2-201, 53-6-113, MCA; IMP, 53-6-101, 53-6-113, 53-6-141, MCA; NEW, 1988 MAR p. 2228, Eff. 10/14/88; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2012 MAR p. 2625, Eff. 1/1/13.